US20040230236A1 - Papillary muscle stimulation - Google Patents

Papillary muscle stimulation Download PDF

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Publication number
US20040230236A1
US20040230236A1 US10834899 US83489904A US2004230236A1 US 20040230236 A1 US20040230236 A1 US 20040230236A1 US 10834899 US10834899 US 10834899 US 83489904 A US83489904 A US 83489904A US 2004230236 A1 US2004230236 A1 US 2004230236A1
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Patent type
Prior art keywords
electrode
pacing
lead
left
ventricular
Prior art date
Legal status (The legal status is an assumption and is not a legal conclusion. Google has not performed a legal analysis and makes no representation as to the accuracy of the status listed.)
Granted
Application number
US10834899
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US8396549B2 (en )
Inventor
Chester Struble
Frits Prinzen
Pierre Grandjean
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Medtronic Inc
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Medtronic Inc
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    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61NELECTROTHERAPY; MAGNETOTHERAPY; RADIATION THERAPY; ULTRASOUND THERAPY
    • A61N1/00Electrotherapy; Circuits therefor
    • A61N1/02Details
    • A61N1/04Electrodes
    • A61N1/05Electrodes for implantation or insertion into the body, e.g. heart electrode
    • A61N1/0587Epicardial electrode systems; Endocardial electrodes piercing the pericardium
    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61NELECTROTHERAPY; MAGNETOTHERAPY; RADIATION THERAPY; ULTRASOUND THERAPY
    • A61N1/00Electrotherapy; Circuits therefor
    • A61N1/18Applying electric currents by contact electrodes
    • A61N1/32Applying electric currents by contact electrodes alternating or intermittent currents
    • A61N1/36Applying electric currents by contact electrodes alternating or intermittent currents for stimulation
    • A61N1/362Heart stimulators
    • A61N1/3621Heart stimulators for treating or preventing abnormally high heart rate
    • A61N1/3622Heart stimulators for treating or preventing abnormally high heart rate comprising two or more electrodes co-operating with different heart regions
    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61NELECTROTHERAPY; MAGNETOTHERAPY; RADIATION THERAPY; ULTRASOUND THERAPY
    • A61N1/00Electrotherapy; Circuits therefor
    • A61N1/18Applying electric currents by contact electrodes
    • A61N1/32Applying electric currents by contact electrodes alternating or intermittent currents
    • A61N1/36Applying electric currents by contact electrodes alternating or intermittent currents for stimulation
    • A61N1/36014External stimulators, e.g. with patch electrodes
    • A61N1/36017External stimulators, e.g. with patch electrodes with leads or electrodes penetrating the skin

Abstract

A method for pacing a left ventricle of a heart includes delivering a pacing pulse via a first electrode to activate a first papillary muscle and another pacing pulse via a second electrode to activate a second papillary muscle.

Description

    RELATED APPLICATIONS
  • [0001]
    This application is a continuation-in-part of U.S. Application 60/333,762, which is incorporated by reference in its entirety herein; U.S. Application 60/333,762 was filed Nov. 29, 2001 and converted from a provisional to a non-provisional application on Nov. 29. 2002, under Ser. No. 10/360,765. Furthermore, cross-reference is hereby made to the commonly assigned related U.S. application Ser. No. ______ (Attorney Docket No. P-9774.06) entitled “Trans-septal Pacing Method and Apparatus” filed concurrently herewith and incorporated by reference in its entirety herein.
  • TECHNICAL FIELD
  • [0002]
    The present invention relates to implantable medical devices and more particularly to left-ventricular papillary muscle stimulation.
  • BACKGROUND
  • [0003]
    Patients with poor atrio-ventricular conduction or poor sinus node function typically receive pacemaker implants to restore a normal heart rate. For another set of patients suffering from left bundle branch block (LBBB), left ventricular pacing and/or bi-ventricular pacing has been shown to significantly improve cardiac hemodynamics and quality of life. However, some studies have shown that traditional pacing from a right ventricular (RV) apex can impair cardiac pumping performance. In some instances, ventricular wall abnormalities (ventricular remodeling) resulting from RV apical pacing have also been observed. So, alternative sites have been found where pacing can cause an electrical activation sequence similar to that in a normally activated heart and thus contribute to improved cardiac pump function.
  • [0004]
    From the literature there appear to be three major characteristics of normal cardiac electrical activation: 1.) Earlier activation of the left ventricle than right ventricle; 2.) Earlier endocardial activation than epicardial activation in left ventricular free wall; and 3.) Earlier activation in the apex than in the base of both ventricles. It has been found that a site of earliest activation occurs in the endocardium of the left ventricle along a lower portion of the inter-ventricular septum (i.e. near the apex) where the septum joins with the anterior wall of the heart and in close proximity to bases of left ventricular papillary muscles. Proper timing of papillary muscle activation is necessary to cause closure of the mitral valve prior to main left ventricular contraction so that regurgitation is prevented.
  • BRIEF DESCRIPTION OF THE DRAWINGS
  • [0005]
    The following drawings are illustrative of particular embodiments of the invention and therefore do not limit its scope, but are presented to assist in providing a proper understanding of the invention. The drawings are not to scale (unless so stated) and are intended for use in conjunction with the explanations in the following detailed description. The present invention will hereinafter be described in conjunction with the appended drawings, wherein like numerals denote like elements, and:
  • [0006]
    [0006]FIG. 1 is a schematic section through a heart wherein a pacing lead according to one embodiment of the present invention is implanted; and
  • [0007]
    [0007]FIG. 2 is a plan view of a distal portion of a delivery system according to an embodiment of the present invention.
  • DETAILED DESCRIPTION
  • [0008]
    The following description is exemplary in nature and is not intended to limit the scope, applicability, or configuration of the invention in any way. Rather, the following description provides a practical illustration for implementing exemplary embodiments of the invention.
  • [0009]
    [0009]FIG. 1 is a schematic section through a heart wherein a distal portion of a pacing lead 100 according to one embodiment of the present invention is implanted. Materials forming lead 100 and an arrangement of conductors, insulation and connector components, which couple lead 100 to a pacemaker device (not shown), may all conform to that of standard pacing leads. FIG. 1 illustrates the distal portion of lead 100 extending through a ventricular apex 9 of a left ventricle 5 having been inserted epicardially per arrow A in an anterior to posterior direction; lead 100 includes a first electrode 140 that has been positioned in proximity to a posterior papillary muscle 14 and a second electrode 160 that has been positioned in proximity to an anterior papillary muscle 160. Papillary muscles 14 and 16 are joined to a mitral valve 6 via chordae tendineae 19 and, according to some embodiments of the present invention, electrodes 140 and 160 are positioned to deliver pacing pulses in proximity to papillary muscles in order to activate mitral valve closure prior to left ventricular contraction and thus prevent regurgitation of blood back into a left atrium 8.
  • [0010]
    According to an alternate method of the present invention, papillary muscle conduction is isolated from that in the surrounding myocardium by means of ablation; such isolation may enable pacing to better control papillary action independent of myocardial activation. Means described herein for delivering lead 100 may also be used to deliver an ablation catheter to the site of the papillary muscles for ablating around the base thereof prior to pacing with implanted lead 100.
  • [0011]
    [0011]FIG. 1 further illustrates lead 100 including a third electrode 120 located in between first electrode 140 and second electrode 160; according to the illustrated embodiment, third electrode 120 functions as an anode and forms a first bipolar pair with first electrode 140 to pace and sense in proximity to posterior papillary muscle 14 and a second bipolar pair with second electrode 160 to pace and sense in proximity to anterior papillary muscle 16. According to an alternate embodiment of the present invention, third electrode 120 is not included and first and second electrodes 140 and 160 operate either in a unipolar mode or are adapted to alternate between polarities for bipolar operation such that, in one point in time, first electrode 140 is a cathode and second electrode 160 an anode for pacing in proximity to posterior papillary muscle 14, and at another point in time, second electrode 160 is the cathode and first electrode 140 is the anode for pacing in proximity to anterior papillary muscle 16. Furthermore, according to one embodiment, pacing pulses, delivered via first and second electrodes 140 and 160 (unipolar or bipolar, with third electrode 120), are delivered simultaneously, while, according to an alternate embodiment, the pacing pulses are delivered with a delay between the pulses, the delay dependent upon local tissue depolarization speed and electrical—mechanical coupling characteristics. State of the art electrode features including surface areas, macro and micro, and surface structure and treatments may be incorporated into some embodiments of the present invention.
  • [0012]
    [0012]FIG. 1 also illustrates first electrode sized to serve as an anti-retraction feature, that is electrode 140 is oversized or includes an outer surface protruding radially from an adjacent portion of lead 100 just proximal to electrode 140. Although not illustrated in FIG. 1 lead 100 may further include a tine-like structure just distal to first electrode 140; such a structure is described in aforementioned co-pending application entitled “Trans-septal Pacing Method and Apparatus” filed concurrently herewith and incorporated by reference.
  • [0013]
    An alternate endocardial approach for insertion of the distal end of lead 100 is illustrated in part in FIG. 1. Lead 100 may be passed through a right atrium 3 and a tricuspid valve 2 into a right ventricle 4 via a standard transvenous route, which may accessed by cephalic cut-down or subclavian stick, and the distal portion of lead 100 inserted through an interventricular septal wall 7 toward left ventricular apex 9, approximately via arrow B, to position electrodes 140, 160, and 120 (if present) in proximity to papillary muscles 14 and 16; a curved puncture needle may be required to create an appropriate pathway for lead insertion.
  • [0014]
    [0014]FIG. 2 is a plan view of a distal portion of a delivery system according to an embodiment of the present invention. FIG. 2 illustrates the delivery system including a guiding catheter 25, a septal puncture needle 20 slideably received within the guiding catheter 25, and lead 100 slideably received within puncture needle 20. According to the illustrated embodiment, catheter 25 would be positioned, via a thorascopic port, against an endocardial surface of left ventricular apex 9 (FIG. 1) so that needle 20, passing through catheter 25 may puncture through apex 9; guiding catheter 25 may be of a type of guiding catheter well known to those skilled in the art, which is constructed having a shape enabling positioning for a selected puncture site and a stiffness sufficient to provide backup support for puncturing. Once a passageway is established by needle 20, lead 100 is passed through and positioned as illustrated in FIG. 1. According to other embodiments of the present invention, an alternate method for passing lead 100 through apex 9 includes first piercing through apex 9 with a tool to make a bore and then removing the tool to pass lead 100 through the bore. According to yet another embodiment, lead 100 includes a piercing tip so that lead 100, reinforced by an internal stiffening stylet may pierce through apex 9 without need for an independent piercing tool.
  • [0015]
    [0015]FIG. 2 further illustrates an electrode 21 coupled in proximity to a distal end of needle 20 which may be used to sense and/or pace as needle 20 passes through apex 9. Once lead 100 has been passed through apex 9, needle 20 is pulled back out from apex 9 and guiding catheter 25 is removed from the access port; then lead may be coupled to a pacemaker device positioned in an abdominal pocket according to means known to those skilled in the art.
  • [0016]
    It may be appreciated that various modifications and changes can be made to the various embodiments described herein without departing from the scope of the invention as set forth in the appended claims.

Claims (12)

    What is claimed is:
  1. 1. A method for pacing a left ventricle of a heart comprising the steps of:
    positioning a first electrode in proximity to a base of a first left ventricular papillary muscle;
    positioning a second electrode in proximity to a base of a second left ventricular papillary muscle; and
    delivering a pacing pulse via the first electrode to activate the first papillary muscle and another pacing pulse via the second electrode to activate the second papillary muscle.
  2. 2. The method of claim 1, wherein the pacing pulses, delivered via the first and second electrodes, are delivered simultaneously.
  3. 3. The method of claim 1, wherein the pacing pulses, delivered via the first and second electrodes, are delivered with a delay between the pulses.
  4. 4. The method of claim 1, wherein the steps of positioning the first and second electrodes includes the step of inserting a distal portion of a pacing lead including the first and second electrodes coupled thereto into a left ventricular apex.
  5. 5. The method of claim 4, wherein the distal portion of the lead further includes a third electrode coupled thereto in between the first electrode and the second electrode in order that the third electrode forms a first bipolar pair with the first electrode and a second bipolar pair with the second electrode.
  6. 6. The method of claim 4, wherein the distal portion of the pacing lead is inserted into the left ventricular apex from an epicardial approach.
  7. 7. The method of claim 6, wherein the step of inserting is preceded by a step of passing a guiding catheter through a thorascopic access port such that a distal end of the guiding catheter contacts the left ventricular apex to form a conduit for passage of the distal portion of the pacing lead.
  8. 8. The method of claim 6, wherein the step of inserting is preceded by a step of puncturing through the left ventricular apex with a puncture needle.
  9. 9. The method of claim 8, wherein the distal portion of the lead is inserted into the left ventricular apex through a lumen of the puncture needle.
  10. 10. The method of claim 4, wherein the distal portion of the pacing lead is inserted into the left ventricular apex from a right ventricle via an endocardial trans-septal approach.
  11. 11. The method of claim 1, further comprising the step of isolating conduction within the first and second left ventricular papillary muscles from myocardial conduction of the left ventricle prior to delivering the pacing pulses.
  12. 12. The method of claim 11, wherein the means for isolating comprises ablation.
US10834899 2001-11-29 2004-04-28 Papillary muscle stimulation Active 2025-02-13 US8396549B2 (en)

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US36076501 true 2001-11-29 2001-11-29
US10834899 US8396549B2 (en) 2001-11-29 2004-04-28 Papillary muscle stimulation

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US10834899 US8396549B2 (en) 2001-11-29 2004-04-28 Papillary muscle stimulation
PCT/US2005/012239 WO2005107860A2 (en) 2004-04-28 2005-04-12 Papillary muscle stimulation

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Cited By (3)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
US20060173505A1 (en) * 2005-01-28 2006-08-03 Salo Rodney W Controlled delivery of electrical pacing therapy for treating mitral regurgitation
WO2008124110A2 (en) * 2007-04-09 2008-10-16 Transcardiac Therapeutics, Inc. Methods for endocardiac ablation
GB2505843A (en) * 2011-07-07 2014-03-12 Clark J L Inc Tablet dispenser

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US5267560A (en) * 1990-09-07 1993-12-07 Cohen Fred M Methods for control of the ventricular activation sequence
US5327909A (en) * 1991-04-26 1994-07-12 Angeion Corporation Epicardial defibrillator lead
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US5431649A (en) * 1993-08-27 1995-07-11 Medtronic, Inc. Method and apparatus for R-F ablation
US5540727A (en) * 1994-11-15 1996-07-30 Cardiac Pacemakers, Inc. Method and apparatus to automatically optimize the pacing mode and pacing cycle parameters of a dual chamber pacemaker
US5584868A (en) * 1992-11-03 1996-12-17 Cardiac Pacemakers, Inc. Cardiac stimulating apparatus and method for heart failure therapy
US5618287A (en) * 1994-01-28 1997-04-08 Thomas J. Fogarty Methods of surgically implanting a defibrillator electrode within a patient
US5643330A (en) * 1994-01-24 1997-07-01 Medtronic, Inc. Multichannel apparatus for epidural spinal cord stimulation
US5683447A (en) * 1995-12-19 1997-11-04 Ventritex, Inc. Lead with septal defibrillation and pacing electrodes
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US5728140A (en) * 1996-06-17 1998-03-17 Cardiac Pacemakers, Inc. Method for evoking capture of left ventricle using transeptal pacing lead
US5800465A (en) * 1996-06-18 1998-09-01 Medtronic, Inc. System and method for multisite steering of cardiac stimuli
US5895416A (en) * 1997-03-12 1999-04-20 Medtronic, Inc. Method and apparatus for controlling and steering an electric field
US5916243A (en) * 1992-11-24 1999-06-29 Cardiac Pacemakers, Inc. Implantable conformal coil patch electrode with multiple conductive elements for cardioversion and defibrillation
US5951543A (en) * 1997-06-30 1999-09-14 Clinicon Corporation Delivery system and method for surgical laser
US6285906B1 (en) * 1999-05-26 2001-09-04 Impulse Dynamics N. V. Muscle contraction assist device
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US20020173826A1 (en) * 2001-05-21 2002-11-21 Lincoln William C. Cardiac rhythm management system selecting A-V delay based on interval between atrial depolarization and mitral valve closure
US20030078671A1 (en) * 2001-04-27 2003-04-24 Lesniak Jeanne M. Prevention of myocardial infarction induced ventricular expansion and remodeling
US20030199938A1 (en) * 2002-04-22 2003-10-23 Karel Smits Precise cardiac lead placement based on impedance measurements

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US3857399A (en) * 1970-03-24 1974-12-31 F Zacouto Heart pacer
US5095916A (en) * 1985-06-20 1992-03-17 Medtronic, Inc. Cardioversion and defibrillation lead system
US4928588A (en) * 1988-02-01 1990-05-29 Walter Mathis Apparatus for dry printing onto a workpiece using a hot embossing film and an embossing die
US5267560A (en) * 1990-09-07 1993-12-07 Cohen Fred M Methods for control of the ventricular activation sequence
US5327909A (en) * 1991-04-26 1994-07-12 Angeion Corporation Epicardial defibrillator lead
US5584868A (en) * 1992-11-03 1996-12-17 Cardiac Pacemakers, Inc. Cardiac stimulating apparatus and method for heart failure therapy
US5916243A (en) * 1992-11-24 1999-06-29 Cardiac Pacemakers, Inc. Implantable conformal coil patch electrode with multiple conductive elements for cardioversion and defibrillation
US5385579A (en) * 1993-03-30 1995-01-31 Siemens Pacesetter, Inc. Myocardial body implantable lead
US5431649A (en) * 1993-08-27 1995-07-11 Medtronic, Inc. Method and apparatus for R-F ablation
US5643330A (en) * 1994-01-24 1997-07-01 Medtronic, Inc. Multichannel apparatus for epidural spinal cord stimulation
US5618287A (en) * 1994-01-28 1997-04-08 Thomas J. Fogarty Methods of surgically implanting a defibrillator electrode within a patient
US5540727A (en) * 1994-11-15 1996-07-30 Cardiac Pacemakers, Inc. Method and apparatus to automatically optimize the pacing mode and pacing cycle parameters of a dual chamber pacemaker
US5683447A (en) * 1995-12-19 1997-11-04 Ventritex, Inc. Lead with septal defibrillation and pacing electrodes
US5716392A (en) * 1996-01-05 1998-02-10 Medtronic, Inc. Minimally invasive medical electrical lead
US5728140A (en) * 1996-06-17 1998-03-17 Cardiac Pacemakers, Inc. Method for evoking capture of left ventricle using transeptal pacing lead
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US5895416A (en) * 1997-03-12 1999-04-20 Medtronic, Inc. Method and apparatus for controlling and steering an electric field
US5951543A (en) * 1997-06-30 1999-09-14 Clinicon Corporation Delivery system and method for surgical laser
US6285906B1 (en) * 1999-05-26 2001-09-04 Impulse Dynamics N. V. Muscle contraction assist device
US20020082651A1 (en) * 2000-12-26 2002-06-27 Stahmann Jeffrey E. Pacing and sensing vectors
US20030078671A1 (en) * 2001-04-27 2003-04-24 Lesniak Jeanne M. Prevention of myocardial infarction induced ventricular expansion and remodeling
US20020173826A1 (en) * 2001-05-21 2002-11-21 Lincoln William C. Cardiac rhythm management system selecting A-V delay based on interval between atrial depolarization and mitral valve closure
US20030199938A1 (en) * 2002-04-22 2003-10-23 Karel Smits Precise cardiac lead placement based on impedance measurements

Cited By (4)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
US20060173505A1 (en) * 2005-01-28 2006-08-03 Salo Rodney W Controlled delivery of electrical pacing therapy for treating mitral regurgitation
WO2008124110A2 (en) * 2007-04-09 2008-10-16 Transcardiac Therapeutics, Inc. Methods for endocardiac ablation
WO2008124110A3 (en) * 2007-04-09 2008-12-24 Omar M Lattouf Methods for endocardiac ablation
GB2505843A (en) * 2011-07-07 2014-03-12 Clark J L Inc Tablet dispenser

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US8396549B2 (en) 2013-03-12 grant
WO2005107860A2 (en) 2005-11-17 application

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